Drug Cost Management

Here are the options at your disposal to help you manage drug costs.

Plan members’ contribution to drug costs

This measure makes plan members aware of drug costs. Their contribution could take a variety of forms, including an annual deductible, a deductible by drug, co-insurance or other options.

Generic Substitution Plan

In a generic substitution plan, drug reimbursement is based on the cost of the least expensive generic drug, which creates a financial incentive for plan members to choose less expensive drugs.

Tiered Plan

A tiered plan features different reimbursement levels (tiers) depending on the drug purchased. It encourages plan members to use the most cost-effective drugs available.

Managed Drug Formulary

You may choose among existing lists or create a customized list that meets the specific needs of your group to determine which drugs will be covered under your group plan.

A few simple actions from your plan members can make quite a difference on the overall drug cost of your plan. Here are few easy ways in which plan members can help:

Shop around

Save from 10% to 50% on the price of medication by choosing a pharmacy that offers competitive prices. Drug costs can vary considerably from one pharmacy to another.

Go for the generic drug

Save from 30% to 75% on the price while still getting the same medicinal benefits by purchasing the generic version of a drug, when it is available.

Learn more about medications of the same therapeutic class 

Save by choosing a drug that treats an illness in a similar fashion to the one prescribed while costing less. Inquire to your doctor and pharmacist.

Follow the doctor’s orders

Taking the prescribed dose of your medication and completing the treatment prevents you from further complications and additional drug costs.

Buy in bulk

Save on dispensing fees for medication taken on the regular basis by asking the pharmacist for a 3-month prescription instead of just one.

Here are some of the measures that we have implemented in an effort to help you efficiently manage your drug costs:

WebRx

Available in My Client Space and via the iA mobile app, this tool provides information about your drug coverage, allows you to estimate the amount of a drug reimbursement under your plan and provides tips to save more.

Prior Authorization Drugs

This initiative ensures that expensive drugs included in the prior authorization list are only reimbursed when they are prescribed for the purpose for which they were created.

Proactive Detection of Healthcare Fraud and Abuse

This measure helps to detect and put an end to questionable claims practices by targeting problematic claims and the service providers involved.

Coordination of Benefits

Coordination of Benefits prevents duplicate payments and ensures that the total amount reimbursed under different plans does not exceed 100% of the actual expense incurred by the plan member.

Hospital Drug Program

This program assures that your private drug plan does not pay for drugs intended to be administered at the hospital or at an outpatient location.

For more information about drug cost management, please consult the Drug Cost Management Guide